Saturday, June 28, 2014

What is and what is true
depends on one’s perspective. One hundred years ago today, the assassinations in Sarajevo of Archduke Franz Ferdinand, the heir to the throne of the Austro-Hungarian Empire, and his pregnant wife Sophie by the young Serbian nationalist Gavrilo Princip propelled humanity into the bloodiest century ever, almost 17 million deaths in WWI, and, after German humiliation contributing to the later rise of fascism, over 80 million in WWII.

Differing perspectives? In Sarajevo today, Princip is seen by Serbians, not as an assassin but as a liberation hero for his stand against the occupation and aggression of the Austro-Hungarian Empire, while non-Serb Bosnians see Princip as the forerunner of the Serbians who bombed Sarajevo in the 1990’s and, in ethnic cleansing, killed so many of its citizens. After WWI, Christian Yogoslavians claimed this atheist revolutionary as a martyr, and, after WWII, Communist Yugoslavia praised him as pan-Yugoslav patriot.

So we hold our theories and truths very lightly as we re-write, rather, re-configure with patients' their histories. New neuronal connections allow for an increasingly expanded repertoire from which to construct 'truth' about what has been, but the negotiation of relationship on an ever shifting foundation can give motion sickness to its participants. Today the contemporary analyst has given up her perch
as the arbitrator of truth and struggles to welcome in a kaleidoscope of
emerging and ever changing points of view found within both her patient and herself.
This poses its difficulties for patients who need a definitive answer on what
is and what was. Likewise, it poses difficulty for the analyst who finds
uncertainty anxiety provoking.

Wednesday, June 25, 2014

Anotherinteresting paper on countertransference is byZachrisson who sees countertransference as “the analyst’s
participation in the relationship.” He writes, “Countertransference refers to something happening in
the analyst. …Something takes place in the analyst threatening to bring him or
her out of analytic position.” In other words, it may threaten the analytic frame by vitiating
the therapist’s analytic attitude. It may seem that Zachrisson has the old
fashioned view of seeing countertransference as something to be avoided, but
instead he writes “An essential
aspect of analytic attitude is precisely this: to allow the expression of what
is in the patient's psyche, irrespective of which feelings or thoughts are
there, and regardless of what feelings these may evoke in the analyst.” These feelings are to be borne and reflected upon by the
analyst, and I would add, reflected upon by both participants. If, as Lachmann
intimates, co-construction includes countertransference, then would it not
follow that exploration which situates both participants in its construction
ought to be part of a necessary negotiation?

Odgen makes use of countertransference and “the
subjective contribution of the analyst,” Zachrisson writes, and advocates “analysis
of this intersubjective construction” to aid the analyst in accessing “the
patient’s inner states.” Because “[s]ubjectivity is present ubiquitously” Zachrisson
uses Ogden’s concept of the analytic third to help ‘contain’ both “the
subjectivity of the analyst” and “the ubiquity of counter transference.” Furthermore,
Zachrisson takes Aron’s ideas about the analytic endeavor being both mutual and
asymmetric, the latter making expressions by the analyst “both important and
complicated” and reminds the analyst that “such openness must be conscious,
clear, and contemplated.” Here I would
interject that this would be the ideal, and as such, unattainable, for
enactments, sometimes through spontaneous disclosures, are inevitable. Where
the analyst can be more easily mindful is in the attitude to allow everything
in from the patient, including the painful explication of the effect on the
patient of the analyst’s missteps. As
Zachrisson puts it, “In the intersubjective perspective, the analyst’s
relationship to the patient is marked by a high degree of mutual subjectivity.”

Zachrisson cautions, “It is decisive to differentiate
the case where the analyst enacts his own needs from the case where the primary
aim is to communicate an understanding of the patient’s inner world or of the actual
relationship. … If he manages to keep his reflecting stance, the
countertransference can be useful. If he loses it, the countertransference
becomes disturbing.”

Saturday, June 21, 2014

Can candidates in training, or even seasoned analysts,
ever tire of discussing our ‘countertransference’ and the importance of our self
reflection? At TBIPS we include the analyst’s contribution— inadvertent or
deliberate, explicit or implicit— in our discussions throughout the training,
and in every course. Heimann extended the Freudian concept of
countertransference (the analyst’s neurotic transference to the patient) to
include all feelings and reactions to the patient, acknowledging that
countertransference provided useful information about the patient, even
positing that the patient created the countertransference. Thus, countertransference
was not to be eschewed but, instead, utilized. Lachmann poses the question of
whether we are ready to dispense with the term ‘countertransference’
altogether.

Lachmann, from his Self Psychology approach, advocates
that the analyst provide (ideally, always) a self object experience for the
patient. He gives a clinical example of how he welcomed in Cecilia’s
inexhaustible talk about her favorite soap opera. One TBIPS candidate, Stavros
Charalambides, noted that Lachmann missed an opportunity for negotiation when
he did not pose to Cecilia whether she wanted the analyst to continue listening
to the lives of her soap opera characters or whether she wanted to consider if
something else might also be worthy of their attention. My Relational bias
wonders, too, whether it does a disservice to a patient when we deprive them of
knowing their impact on us. I greatly admire Lachmann’s work and often assign
his papers, but I, too, was left wanting more from the clinical vignette in his paper. Perhaps Cecelia, over time, goes further than the connection to her
mother merely through a soap opera. Maybe Cecilia’s mother can offer nothing
more, but how sad if this remains their only connection. Maybe Cecilia’s father
can never connect to her except when she does for him, like compiling a book
about him. Maybe Cecilia’s acceptance of what little her parents are capable of
offering was great progress. But what if an inadvertent outcome for Cecilia was that she had become a self object
experience for her parents just as Lachman was for Cecilia, and that she never
learns to negotiate to include her own needs?

Lachmann is a great fan of co-construction, now termed
co-creation, and wrote with Beebe a wonderful paper on mutual regulation
between infant and mother, but I had some questions about why Lachmann does not
extend co-construction to include countertransference when he writes “…even if I had felt angry, that would not
indicate to me that Cecilia's motivation was to make me angry.”
Lachmann, I suppose, is considering other motivations of Celia’s, such as the
attempt to make a connection, or an attempt to know her analyst’s mind, for
example, which only as a by-product might make her analyst angry. Because
Lachmann sees co-construction as “understood,” he does not tell us where the
analyst’s contribution is to the Self psychologist’s two dimensions of
transference: the self object dimension
and the representational dimension.
Sometimes, I need it made explicit, as may the patient.

Registrationdeadline is
August 1, 2014and includesa subscription to PEP (psychoanalytic electronic
publishing). Fee:
$250 for a single course; $200 per course if enrolled in 3 or more courses.

Developmental Issues: Narcissismand the Development
of Shame Throughout the Life Cycle

(16 weeks) Wednesdays
8:00am-9:15am This course
offers a contemporary understanding of narcissism, both its developmentally
appropriate and pathological aspects, with an emphasis on its primary affect
shame, and helping the clinician to avoid engendering shame in the therapeutic
situation. It includes discussion of envy and rage and deficits in
mentalization. We emphasize recognition, containment, empathy and mirroring. Instructor:
Lycia Alexander-Guerra

Clinical Case Conference(16weeks) Wednesdays
9:30am-10:45pm This course is
designed to support the clinician’s work and offers opportunity to integrate
clinical material with psychoanalytic concepts, including ethics, and ways to
deepen the psychoanalytic process, with a focus on the therapist’s self
reflection, the clinical relationship, and ways to facilitate what is mutative
for the patient. Attendees are encouraged to present case material. Instructor:
Lauren Levine

Relational
Concepts and Methodology I (16 weeks) Wednesdays 11:00am-12:15am This course is designed to elucidate
some of the differences between classical and postclassical psychoanalytic
thinking. We will compare assumptions about the mind, compare ideas about
clinical process, and consider how relationship is built, maintained, and
repaired. With an emphasis on the analyst’s self reflection we will explore how
we locate ourselves in the therapeutic process. Instructor: Susan Horky

Psychosoma I
(16 weeks) Wednesdays
11:00am-12:15pm We view hypochondriacal and psychosomatic symptoms as
communication of past trauma. This course focuses on helping clinicians with
patients who are alexythymic, i.e. have no words for experience—a population
often confounding and daunting for the
therapist—and instead express their experience through physical symptoms. We
will review an historical perspective and the current psychoanalytic literature
on psychosomatic thought. We discuss how embodied experience represents an expansion
of the analyst’s work in both transferential and countertransferential. Some
specific organ systems (pulmonary,
reproductive, skin, etc) are highlighted. Instructor: Lycia Alexander-Guerra

Hate, Envy, and Destructiveness in the Clinical Situation(16 weeks) Wednesdays 12:30 pm -1:45pm Working with the affectively
dysregulated patient presents increased challenges for the clinician, including
the need to survive (i.e., neither withdraw from nor retaliate against the
patient). Negotiating intersubjective space will be discussed, as will
contributions from object relations and how understanding trauma informs our
interpersonal interactions. Fee: $250 for a single course; $200 if enrolled in
full semester. Instructor:
Lorrie Gold

TBIPS FALL 2014 REGISTRATION FORM

______Developmental Issues:
Narcissismand the Development of Shame
Throughout the Life Cycle (16 weeks) Wednesdays 8:00am-9:15am Sep 17, 2014 – Jan 28, 2015. Fee: $250 for a single course; $200
if enrolled in 3 or more courses.

Registration
deadline is August 1, 2014. Deadline is for all application material, registration
form, and payment. We cannot provide papers through a subscription to PEP
(psychoanalytic electronic publishing) unless make deadline.

Saturday, June 14, 2014

Aron enumerates
various ways we conceive of "something beyond the dyad” called the [analytic]
third: “a context within which we emerge, … an
emergent property of dyadic interaction and … a dyadic achievement that creates
the psychic space necessary for reflexive self-awareness and mentalization" (the understanding
that the other has contents of mind, as well, and different from one’s own—an
important and necessary component for mutual recognition of relational intersubjectivity).
What a recognition of paradox regarding the third: that we emerge from it, as
well as it from us, and it is something we create and utilize.

What makes the
analytic third so useful? Aron, and Benjamin, state that “thirdness…allows the
analyst to restore a process of identification with the patient’s position without
losing her own perspective.” This is a refreshing experience of learning
negotiation procedurally for a patient raised in an environment of negation (“where
the acceptance of one person’s subjectivity meant an obliteration of the other’s”).
Learned complementarity— your way or my way, no in between— can ensue, and
play out in the transference-countertransference dialectic, and an analytic impasse may result. Aron tells us
that this impasse can sometimes be averted by opening the intersubjective space
to create an analytic third where the analyst is open to the patient’s multiple
and contradictory identifications.

Benjamin delineates
two types of the third: The ‘one-in-the-third’ (the rhythmic third) — where
oneness is experienced in a rhythmic pattern between two such as reciprocal
speech or eye gaze, is dyadic and exists early (pre-oedipal) in relationship— and
the ‘third-in-the-one’ – where the conflict within the mind of one can act as a
third position. For some, like Britton, where
the ‘triangular’ space is created in the analyst’s mind, the mother's mind
creates the third position. For Benjamin, the rhythmic third emerges, not from
one mind, but from within the dyad. Her third-in-the-one (the intentional
third), on the other hand, says Aron, "creates a space for differentiation"
[from oneness], much like 'marking' (described
by Gergely when the mother givesherversion of the infant's response,
differentiating her response as a reflective mirroring rather than one
generated from within her. The infant has the capacity to see the mother's
response as separate from its own.) Marking, then, is not a perfect match, but
a reflection, as well, of otherness, a kind of mirroring that "is a dyadic
phenomenon, functioning as a differentiating third point emerging between"
two people and, as such, does not
require a third person to separate the infant from the mother. Marking creates
the third-in-the-one [in the one dyad]. We can have both the connection, in the
one-in-the-third, and difference, in the third-in-the-one.

Aron notes
that the Lousanne group’s investigation of triangularity in infancy shows the
capacity at an early age to have triadic interactions between two people (e.g.,
from the mother’s mind emerges a third position) indicating that triangularity
can no longer be conceived as the hallmark of the oedipal phase. The child no
longer needs the primal scene (relationship of parents which excludes the
child) to have experience with the third. Rather, the child is privy to the emerging
third position within the mother’s mind. A third point of reference can emerge
from the dyad within the mind of one and, when shared, can facilitate self-reflection
and mentalization.

Aron points out how
certain self disclosures by the analyst can create thirdness in the analytic
dyad. When the analyst lets her mind be
known (when , e.g., she disagrees with herself or is of two minds [e.g. I
want to respond to your request for advice, but concerned that, if I do, I
would be too much like your controlling, know-it-all father”]— that is, where
analysts disclose "aspects of their inner processes"—a thirdness
is introduced in the dyad, where the disclosure itself can serve as the strange
attractor (from chaos theory, which allows the possibility to shake up linear thinking
and have a reconfiguration of elements). Aron writes, “[T]he analyst’s reflexive
self-awareness, a dialogue with one’s self, creates a third point.” When made
explicit, the patient becomes privy to the analyst’s mind, both its contents
and its way of working. It is this third
point of view which allows for the third space, and in this space, both analyst
and patient can think together about connection and difference.

See also on this same paper the post of Jan 27, 2013. Compare
and contrast it to ideas in Aron’s 1995 paper (in the post of Jun 8, 2014.)

Wednesday, June 11, 2014

The Railway Man (2014),
directed by Australian Jonathan Teplizky (Burning
Man) and starring Colin Firth as the older, WWII veteran Eric Lomax— who quietly
suffered decades with Post Traumatic Stress Disorder (PTSD), aggravated perhaps
by the stiff upper lip, nobody talks about such things society — is based on Lomax’s 1995
memoir of his capture in Singapore in 1942, where he was forced to work on building
the Thai-Burma railroad, his torture in a Japanese POW camp— younger Lomax
portrayed by Jeremy Irvine (War Horse)—
and the eventual, decades later, confronting of his torturer Takashi Nagase
(Hiroyuki Sanada— 47 Ronin, The Last Samurai); the Young Nagase
(Tanroh Ishida). In this role, Firth is a changed man from his usual handsome
and sometimes comedic presence. He has the haggard look of the perpetually
haunted, the vacant look of the dissociated. Firth had met with Lomax before
the latter’s death in 2012, and understood from him some of Lomax's utter exposure,
degradation and the vulnerability
experienced at the hands of his torturer.

Like a therapy session where present and past alternate
foreground and background, — and, inescapably with PTSD, where the past impinges on
the present— Teplitzky’s film moves between the war years and the 1980s.
Torture, the most horrendous of ruptures, is somehow miraculously repaired when
Lomax, returning to Thailand with the intent to torture or kill his torturer, finds that
Nagase is deeply remorseful and has spent his life dedicated to making sure no
one forgets the atrocities committed by him and others. What has led Lomax,
after decades of debilitating flashbacks and nightmares, to have the capacity to
forgive Nagase? If he was aided by the relational home that Lomax’s second wife
Patti (Nicole Kidman) provided for him, we see very little of her in this
film. If he was aided, too, by Helen
Bamber, his therapist at the Medical Foundation for the Care of Victims of
Torture, we see none of her in the film. Perhaps the real life friendship that
later developed between Lomax and Nagase was based on that Nagase might be the only person who could truly understand what had happened to Lomax in the horror of that wartime. Regardless, The Railway Man depicts the most
tremendous of feats of humanity: to forgive the unforgivable.

Sunday, June 8, 2014

Coming to terms with being left out can sometimes
predominate in an analysis. As children, we do not simply internalize objects
(mother, father) but also relationships or patterns of relationships (systems) –
including the perceived relationships of our parents, observed or imagined— and
exclusion from it can be a narcissistic injury. Aron writes, “The child’s wish
to be included represents both a wish for relationship…and an attempt to
maintain self esteem.” In finding ourselves excluded from the parental
relationship and parental interaction (the primal scene as exclusion of the
child from the parental dyad), this exclusion, with its blow to a child’s
grandiosity, becomes an organizer which links narcissism and object relations.

Trauma can disrupt the capacity to pretend, play, and
move freely between identity and multiplicity, between discontinuity and
integration. One cannot enjoy being the object of desire without also having
established one’s own subjectivity and agency. When unable to experience self as
subject with agency, the analysand or the child operating in the
paranoid-schizoid position, in psychic equivalence, fears loss of self and
identity.

The up side of recognition of this exclusion is the
opportunity to experience the self as both subject and an object, which leads
to the possibility of developing the capacity to hold two contrasting ideas
simultaneously – that of being both a subject and object—and, ala Winnicott, the
ability to allow for paradox to be sustained without the need to push for its resolution.
Aron says this capacity for toleration
of contradiction becomes another nidus for regulation of self and object
relations, for creativity, mentalization, symbolization, and even multiplicity of
gender. The capacity to be both subject and object, participant and observer, allows
one to be both subject who desires and object who is desired.

Moreover, experiencing oneself as both subject and object
allows for intersubjectivity and, in the treatment situation, the creation of
an analytic third. Aron writes that the child first lives in a dyadic world, relating
to only one parent a time, until it discovers (in the Oedipal stage) that
parents have a relationship of their own from which the child is excluded. In utilizing
Britton’s ‘triangular space,’ Aron notes it “allows for the possibility of
being a participant in a [dyadic] relationship and observed by a third person
and of being an observer of a relationship between two other people.” The child
is able to identify with self as object and self as subject, and to identify
with other as both subject and object, that is the development of
intersubjectivity. Aron asserts that the
experience with this alternating between participation and observation is what
allows for becoming an analysand.

Wednesday, June 4, 2014

Bowe Bergdahl, a US Army soldier held captive for almost
five years by Taliban forces, was the last and only American POW in Afghanistan
to bring home. But there were controversies surrounding his return, the two
main ones being his exchange for five Taliban detainees from Guantanamo Bay,
and claims that our commander in chief Obama did not have the authority to make such
an exchange. Additionally, there are those who are angry at Bergdahl for leaving
his post, going AWOL, or possibly deserting, and he may face court martial and
prison time. Rumors abound about whether other soldiers died as a direct result
of their search for Bergdahl. One former
US Army Sergeant, Josh Korder, for example, denounces Bergdahl, “He chose to
take off his gear, put down his weapon, and walk away…” and says what Bergdahl
did is “just not forgivable.”

My two older brothers came of age during the Viet Nam
war. This was a time when our country did not whole heartedly “support our
troops,” calling them, for one, “baby killers” –there is a rumor that Bergdahl
saw an American tank run over an Afghani child. Though I am against military
action before diplomacy is exhausted, I am happy that our nation does not now disparage
these young men and women upon their return home.
I additionally advocate that we not disparage troops who, for whatever
reasons, break or break faith. The older
of my two brothers joined up in the late
sixties, his best childhood friend having ‘been the first on our block to come
home in a box’ and the other brother made
his plans to relocate to Canada should his draft number come up. My parents
supported both their sons’ decisions. Looking back, this support of these two
antipodal positions now seems remarkable in this political climate where black and
white are so rigidly demarcated. Though both my brothers fare well today, we
know too well that not all our soldiers come home unscathed. Can we not find compassion for the horrific
pressures troops are placed under?

I am so proud to be a volunteer clinician for TBIPS’ Veterans
Family Initiative which provides pro bono and low fee, long term and
intensive psychotherapy services without any
significant wait time to veterans and
their families. I am so proud, too, that training at TBIPS emphasizes negotiation
of paradox where seemingly contradictory positions are, with our understanding
of multiple self states, welcomed in, each as a necessary part of the whole. We
all strive to be whole and wholly connected. No matter what Bowe Bergdahl has
done or did not do, he remains the beloved son of Jani and Bob, and I, with
them, welcome him home.

Welcome!

Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you.Lycia Alexander-Guerra, M.D.TBIPS PresidentGabcast! Welcome! #3

Tampa Bay Institute for Psychoanalytic Studies

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About TBIPS

In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.